Lymphedema Treatment and Management at Home

The Flexitouch system is an advanced intermittent pneumatic compression device (PCD) that is clinically proven to stimulate the lymphatic system. Flexitouch can be used in combination with other lymphedema treatment components to help you continue or maintain reductions in limb volume between and after clinic visits. Studies have demonstrated the clinical benefits of enhancing lymphedema treatment with PCD treatment to reduce limb volume and increase quality of life. Flexitouch is a pragmatic tool for the daily at-home lymphedema treatment needed for clinically effective lifelong management.

Only swim in public pools if they have been well treated. If possible, have pool management check the water quality prior to use. Always wear rubber soled, water resistant shoes when swimming in the ocean. Be careful of the sun and avoid sunburn. Use SPF 30+ sunscreen on the limb when swimming or when outdoors. Remember, you can get sunburned even on a cloudy day, and it’s best to use sunscreen daily all year round. If you’re traveling for a long time in a car or boat, drape a white shirt over the limb if it is in the sun.

Exercise is important because lymphatic drainage is improved by muscle contraction against an external pressure such as that applied by a compression garment. During exercise, your joints and muscles work together, which creates a pressure difference in the tissue and causes the lymph fluid to move into the lymphatic system, transporting it to healthy regions of the body where it can be processed normally. Exercise moderately and begin any exercise program slowly, increasing gradually while carefully monitoring swollen limbs for changes in swelling. Be aware of fatigue and heaviness of your affected limb during your exercise routine and modify as needed so you don’t experience an increase in swelling.

Compression therapy is a well-established component of therapy. Compression of the limb may be applied in various ways, including multi-layer bandaging, compression stockings, custom compression garments and intermittent pneumatic compression devices. Barriers to effective compression include an inability to apply bandages or compression stockings and decreased tolerance to compression. If you are considering compression therapy, you should be thoroughly evaluated by your physician or therapist to create an effective program to manage symptoms and prevent the progression of swelling.

Complete decongestive therapy (CDT) is a multimodal treatment approach consisting of intensive in-clinic treatment provided by a lymphedema therapist, followed by ongoing self-management at home. The focus of in-clinic CDT is to reduce limb volume and soften fibrosis while equipping you with tools and knowledge to help you succeed with a lifelong successful home management program.

Here are some components of in-clinic CDT:

• Education on the lymphatic system: how lymphedema occurs, skin and nail care and other health precautions specific to the condition
• Gradient compression bandaging
• Manual lymphatic drainage therapy (MLD) is a key component of CDT which employs a sequence of hand motions, consistent with established anatomic and physiological principles, to redirect fluid from congested and swollen areas to functioning lymphatic regions
• Intermittent pneumatic compression (IPC) devices, such as the Flexitouch and Entre systems
• Development of a comprehensive at-home program for effective self-management

Ultimately, if you have lymphedema, you (and possibly your caregivers) will be responsible for managing your symptoms at home. Be honest with your provider about what you can or cannot do so they can ensure you are equipped with the right tools. Here are some examples of treatment components that can be customized to meet your needs:

• Gradient compression garments or bandaging
• Intermittent pneumatic compression (IPC) devices, such as the Flexitouch and Entre systems
• Meticulous skin and nail care to prevent infection
• Daily decongestive exercise

Be sure to let your healthcare provider know about your lymphedema diagnosis before any invasive procedures, such as surgery. While you should take care not to further damage the lymphatics of the affected area, finger pricks, blood draws, injections and blood pressure cuffs have not been proven to increase the risk of, or worsen existing, lymphedema.

Any cut or break, even an insect bite, in the skin of a swollen arm or leg will provide an opening for bacteria to enter the body. If your compromised lymphatics cannot fight off the bacteria, you may get an infection. Take extra care not to bump, cut, bruise or scratch a swollen limb.

Use caution cutting nails. Try to keep your cuticles moist with appropriate creams and pushed back. Never cut your cuticles. Clip your toenails with clippers, not scissors, and cut straight across.

Keep your swollen limb(s) very clean. Wash daily (or more if needed) with mild soap and warm water and dry well. Do not bathe or shower when wearing bandages unless instructed by your healthcare provider to use a waterproof barrier, such as a plastic bag. Avoid very hot water or soaking a swollen limb for an extended time. Damp skin folds are prone to fungal infections so be sure to dry well in all creases between fingers and toes. You may want to use a hair dryer set on the cool setting to help thoroughly dry your skin.

An anti-fungal powder or lotion is recommended for feet if you have lower extremity lymphedema, especially if your feet are moist. Check your skin daily for signs of any changes in skin color or temperature, irritation, blisters, cracks and calluses that could allow bacteria to grow and increase the risk for infection. If no sores are present and the skin is dry, use non-perfumed lotion with low PH, lanolin-based ointments or cocoa butter at bedtime.

Avoid tight, constricting waistbands, belts, cuffs and jewelry as this may impede circulation or lymph flow. Clothing should never bind at the waist, groin, chest, underarm, wrist or ankle. If you wear any rings, watches or bracelets, be sure to wear them loose if they are on an arm or hand at risk. Wear a clean stocking/sleeve daily.

Wear comfortable, adjustable, lace-up shoes that provide cushioning while walking. Tight shoes can create ulcers so be sure to wear well-fitting shoes to avoid skin breakdown or pressure points and break in new shoes slowly. If your foot is swollen, a wide shoe or slipper may be best. Always wear a sock or stocking with shoes and avoid going barefoot at all times. Clean out your shoes before wearing them to make sure there is nothing inside that might irritate your foot.

Elevate swollen limbs whenever possible. Try to elevate the limb above heart level. This will promote drainage of excess fluid out of the extremity. Elevate the leg(s) for 10-15 minutes several times a day. The ankle(s) should be higher than the knees, which should be higher than the heart. Elevate the arm(s) for 10-15 minutes several times a day. The hand should be higher than the elbow, which should be higher than the heart.